On behalf of the American Hospital Association (AHA) and its more than 5,000 member hospitals, health care systems, networks and other providers of care, I am writing to express our strong support for the Patient Safety and Quality Improvement Act of 2003 (S.720).

We commend your leadership and dedication in putting together a bill that lays out a common-sense approach to improving patient safety - a goal that is at the heart of every hospital's mission.

The AHA is committed to seeing enactment of patient safety legislation that will help create a "culture of safety" in which nurses, doctors and others can share information when adverse events happen, engage appropriate outside experts in the analysis of patient safety concerns, and, together, enhance our knowledge of how to prevent medical errors.

As you have recognized, a major obstacle stands in the way of such openness. Currently, patient safety information that is shared among providers or with outside experts is not confidential and is therefore subject to legal proceedings. The Institute of Medicine has called on Congress to knock down this barrier by providing legal protection for information collected to advance patient safety research and education. This bill works toward that goal - a goal the nation's hospitals strongly support.

We are encouraged that, with a House-passed bill already achieved and a bill in the Senate passed out of the Health, Education, Labor, and Pensions Committee with strong bi-partisan support, we should see enactment of this important legislation this year.

In particular, the AHA is pleased that your bill addresses the following important policy concerns:

Statement of Confidentiality: State peer-review laws typically couple a legal privilege with a strong statement of confidentiality. We believe that the language in your bill with respect to confidentiality is critical, as it ensures caution and prudence when sharing patient safety information in circumstances that may be unrelated to litigation.

Legal Privilege: The legal privilege established under this bill will ensure that patient safety data is used appropriately, and is used to encourage a culture of safety, where hospitals and caregivers may freely share information about what may go wrong and why. This is vital, as the Institute of Medicine, the Veterans Hospitals, and numerous other patient safety experts have pointed out, to our national efforts to improve patient safety. When there are ambiguities in the law, or no privilege at all, it has been widely demonstrated that caregivers fear talking openly about patient safety issues. Your bill works to clear up ambiguities, and would clearly establish a safe environment for patient safety analysis, while protecting patients' and their legal representatives' access to information not created for this purpose, such as a patient's medical record. We appreciate the care that has been taken to balance these very important issues, and feel strongly that passage of your bill in the Senate is a critical step toward enactment of much-needed patient safety legislation.

Further, the bill importantly recognizes the importance of standardization to promote the exchange of health care information. The bill permits the Secretary of Health and Human Services sufficient flexibility to take advantage of the broad interest in information standards. For example, as part of the National Alliance for Health Information Technology (NAHIT), the AHA has been engaged in a voluntary consensus standard development process. We are confident that NAHIT would provide useful assistance to the Secretary's efforts that would not only promote the identification of the standards, but also encourage their rapid adoption. It will also be important, as these standards are developed, for the Congress to consider funding issues to ensure that hospitals have adequate resources to implement electronic information systems.

Again, the AHA appreciates your strong leadership on this issue. We extend our commitment to work with you and your staff to achieve a meaningful long-term approach to enhancing the safety of health care in our nation.

Sincerely,

Rick Pollack
Executive Vice President

This letter was sent to Senator Judd Gregg, Senator Bill Frist, Senator James Jeffords, and Senator John Breaux